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Structural changes in the gray matter of the contralateral hemisphere and prognosis of motor function in children with pharmacoresistant epilepsy before and after hemispherotomy
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Structural changes in the gray matter of the contralateral hemisphere and prognosis of motor function in children with pharmacoresistant epilepsy before and after hemispherotomy
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Structural changes in the gray matter of the contralateral hemisphere and prognosis of motor function in children with pharmacoresistant epilepsy before and after hemispherotomy
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Journal Article
Structural changes in the gray matter of the contralateral hemisphere and prognosis of motor function in children with pharmacoresistant epilepsy before and after hemispherotomy
2025
Overview
•This study offers the first evidence of compensatory neuroplastic remodeling in the contralateral prefrontal cortex of children with drug-resistant epilepsy before hemispherotomy.•Cortical thickness of the anterior cingulate gyrus emerges as the strongest predictor of motor recovery after surgery.•An abnormal increase in gray-matter volume within the temporal pole and adjacent temporal regions forecasts poorer functional outcomes.•Integrating VBM and SBM provides a comprehensive map of gray-matter alterations across the pre- and postoperative phases.
Hemispherotomy (HS) is an effective treatment option to control seizures for children with pharmacoresistant epilepsy. We aimed to explore the alteration of the gray matter structure before and after surgery and identify the specific brain regions associated with preoperative neuropsychological development and postoperative motor development.
We conducted a retrospective study of magnetic resonance imaging (MRI) results, clinical parameters and follow-up data in 46 children who underwent hemispherotomy (HS) at our hospital between 2018 and 2022, and 32 controls were included. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) techniques were employed to quantify the alteration of the gray matter structure. We used Spearman rank correlation and logistic regression models to analyze the influence of different factors on neuropsychological development and motor outcome.
46 children with pharmacoresistant epilepsy undergoing hemispherotomy and 32 control subjects were recruited for this study. The patients were divided into two groups according to their surgical side: 29 patients with the left hemispherotomy (13 females, 17 months [IQR, 26 months]) and 17 patients with the right hemispherotomy (11 females, 19 months [IQR, 27.5 months]). Finally, 36 patients completed 13.80±1.54 months (LHS)/ 11.53±1.73 months (RHS) of follow-up, and 89.0 % remained completely seizure-free (outcome scale class IA). The prefrontal cortex showed a positive correlation with neuropsychological development before surgery. Cortical thickness (CT) of the anterior cingulate gyrus was an independent protective factor [OR=18.19, 95 % CI (1.56–212.43), P = 0.021] for motor function prognosis after surgery, while gray matter volume (GMV) of the temporal pole of the middle temporal gyrus was an independent risk factor [OR=0.07, 95 % CI (0.01–0.85), P = 0.037] after surgery.
Preoperative remodeling of prefrontal cortical gray matter structures in the contralateral hemisphere was performed for functional compensation. After surgery, the prefrontal and cingulate cortices resumed the normal developmental trajectories, with the cingulate cortex determining postoperative motor outcome. However, there is irreversible gray matter damage to the temporal lobe, leading to corresponding functional developmental deficits.
Publisher
Elsevier Inc,Elsevier Limited,Elsevier
Subject
/ Child
/ Children
/ Drug Resistant Epilepsy - diagnostic imaging
/ Drug Resistant Epilepsy - pathology
/ Drug Resistant Epilepsy - physiopathology
/ Drug Resistant Epilepsy - surgery
/ Epilepsy
/ Female
/ Gray Matter - diagnostic imaging
/ Humans
/ Infant
/ Male
/ Neuropsychological development
/ Patients
/ Radiology/Diagnostic Imaging
/ Seizures
/ Surgery
